Current status of chemotherapy for gastric cancer

High response rates to combination chemotherapy reported by the end of the seventies led many oncologists to recommend standard treatment for gastric cancer. In randomized trials conducted by different groups, the response rate with fluorouracil (F), adriamycin (A), mitomycin C (M) ranged between 17 and 39% and was advocated for adjuvant treatment. However, further studies indicate that combination chemotherapy has no beneficial effect on survival compared with 5-FU alone. Several studies assessing the FAM regimen versus control in the adjuvant setting show, so far, no difference between the treatment arms. Other agents and combinations have recently been investigated. Cisplatin (P) is active in gastric cancer. In six studies using a combination with FA (FAP), the response rate ranged between 29 and 55% with a median survival of 4-12 months. Other combinations using P with F or etoposide and A have also been promising. Recently, the EORTC Gastrointestinal Group, using a combination of sequence of high dose methotrexate and F with A (FAMTX) reported 22 positive responses out of 66 eligible patients, including nine complete responders. These new treatments are currently being tested by different groups in a randomized trial. For the time being, apart from 5-FU alone, chemotherapy in advanced gastric cancer should not be administered on a routine basis outside clinical trials.